Religious dying patients more likely to get aggressive care

Patients who rely heavily on their religious faith to cope with terminal cancer are more likely to receive intensive life-prolonging measures in their last week of life, Boston researchers reported yesterday.

In a study at Dana-Farber Cancer Institute, Massachusetts General Hospital, and five other sites, 345 people with advanced cancer were interviewed about the importance of religion in dealing with their illness, and their preferences for care. Most of them were Christian.

About 80 percent of the patients said they used religion to some extent to cope with their illness and more than half said they prayed, meditated, or engaged in religious study daily. More than 30 percent said their faith was the most important thing that kept them going.

Patients also were asked if they would choose treatment intended to extend life as long as possible, even if it meant more pain, or if they wanted care that focused on easing pain even if it meant not living as long. The researchers followed the patients to see what care they received in the week before their deaths.

The patients who leaned the most heavily on their faith were nearly three times more likely to choose and receive more aggressive care near death, such as ventilators or cardiopulmonary resuscitation. They were less likely to have advanced care planning in place, such as do-not-resuscitate orders, living wills, and healthcare proxies.

"These results suggest that relying upon religion to cope with terminal cancer may contribute to receiving aggressive medical care near death," the authors write in today's Journal of the American Medical Association. "Because aggressive end-of-life cancer care has been associated with poor quality of death . . . intensive end-of-life care might represent a negative outcome for religious copers."

Dr. Andrea C. Phelps, the lead author and a senior medical resident at Beth Israel Deaconess Medical Center, said previous research has shown a link between religious coping and preferences for "heroic" measures. But this is the first study to focus on these patients' final days.

"We need to better understand what factors of religiousness are involved in decision making," she said in an interview.

The Rev. Angelika Zollfrank, a chaplain and the director of clinical pastoral education at Mass. General, said she was surprised by the outcome of the study, in which she had no role.

"We certainly see religious patients and families go both ways in terms of religious coping," she said in an e-mail interview. "There are very religious people who want aggressive treatment, and there are also religious people who know that there is a time for everything, a time to be born and a time to die."